Interest in alternatives to portacaval shunting for the management of portal hypertension has been the natural consequence of disaffection arising from the publication of controlled trials of that procedure. In the United States, these prospective investigations performed by three separate groups have shown no significant survival benefit when each study is examined separately. Moreover, surgical treatment of the cirrhotic patient with bleeding varices appears to facilitate hepatic failure and metabolic encephalopathy. The mechanism of this post-shunt syndrome has been considered to reflect deprivation of hepatic blood flow and possible hepatotropic pancreatic hormones. In an effort to avoid these sequelae of total shunting, Warren and his colleagues devised the operation of distal splenorenal shunt; this procedure would be anticipated to lower variceal pressure while maintaining prograde portal venous flow to the liver. The technique employed is designed to disconnect the gastrosplenic venous circulation from the splanchnic venous flow. The present study therefore evolved to examine prospectively the benefit/risk ratio for total (portasystemic) shunt versus the selective (Warren or distal splenorenal) shunt in the context of a controlled trial. The experimental design calls for a collaborative arrangement between Boston and New Haven investigators involving a number of hospital teams in the two cities.